Provider Demographics
NPI:1154816619
Name:MATI, BEHNAM (RPH)
Entity Type:Individual
Prefix:
First Name:BEHNAM
Middle Name:
Last Name:MATI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 NE 16TH PL APT 17
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4493
Mailing Address - Country:US
Mailing Address - Phone:425-209-7521
Mailing Address - Fax:
Practice Address - Street 1:3925 236TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-8455
Practice Address - Country:US
Practice Address - Phone:425-836-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60828029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist